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J Thorac Cardiovasc Surg 2009;137:309-313
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: A propensity score analysis

^a Department of Cardiac Surgery, Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
^b Research Department, Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
^c Department of Cardiac Surgery, Cardiovascular Intensive Care Unit, Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina

Received for publication January 28, 2008; revisions received April 24, 2008; accepted for publication August 4, 2008.

^_* Address for reprints: Guillermo N. Vaccarino, MD, Department of Cardiac Surgery, Instituto Cardiovascular de Buenos Aires, Blanco Encalada 1543, Ciudad Autónoma de Buenos Aires, Argentina. (Email: gnvaccarino{at}icba-cardiovascular.com.ar).

Objective: The aim of our study was to evaluate the impact of recent clopidrogel use before off-pump coronary artery bypass grafting on the postoperative risk of bleeding.

Methods: During the period January 2003 to December 2006, 1104 consecutive patients underwent off-pump coronary artery bypass grafting. Patients were divided into two groups according to the recent use of clopidrogel (within 7 days). We performed a propensity score to further adjust for differences between the patients with and without recent use of clopidrogel.

Results: Mean age was 64 ± 14 years and 87% were male. The clopidrogel group had a greater incidence of patients in unstable condition, requiring emergency coronary bypass grafting, and with a high EuroSCORE. Propensity score analysis selected 88 patients with and 176 without recent use of clopidrogel. By propensity score, the clopidrogel group had higher requirements for fresh frozen plasma units (18.1% vs 8.5%; P = .02), reoperation owing to bleeding (5.6% vs 0.5%; P = .009), and higher need for postoperative mechanical ventilation (4% vs 10%; P = .04), whereas mortality and length of stay were similar between groups.

Conclusion: Recent use of clopidogrel before off-pump coronary artery bypass grafting is associated with greater risk for bleeding with similar mortality rate.

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